Anesthesia Peds Exam 1

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Anesthesia Peds Exam 1
2014-11-29 18:58:41
exam one pediatrics
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  1. Acidic and highly protein bound drugs
    • phenytoin
    • salicylate
    • bupivacaine
    • barbituates
    • antibiotics
    • theophylline
    • diazepam
  2. Kernicterus
    a bilirubin induced brain dysfunction
  3. Basic medications such as alfentanil, lidocaine, diphenhydramine, and atropine typically bind to
    plasma alpha-1 acid glycoprotein
  4. Preterm and term infants have a greater proportion of body weight in the form of water than in older children, so
    The net effect on water-soluble medications is a greater Vd in infants--> the loading dose will increase
  5. Examples of water soluble drugs
    • some antibiotics
    • succinylcholine
    • digoxin
  6. intracellular fluid compartments ___________ with age
  7. extracellular fluid compartments _________ with increasing age
  8. Phase 1 metabolic reactions
    • oxidation, reduction, hydrolysis
    • CP450 reactions
    • makes drugs more polar
  9. Phase 2 metabolic reactions
    glucuronidation, sulfation, acetylation

    Increases the hydrophilicity of molecules to facilitate renal excretion
  10. Morphine sulfate, Tylenol, and lorazepam undergo _________ metabolism
    Phase 2- glucuronidation
  11. What is used to treat apnea and bradycardia in infants, and what drug category are they in?
    1. Caffeine and Theophylline

    2. methylxanthines
  12. In terms of renal excretion, what can be expected in premature babies?
    • Immature glomerular filtration and tubular function means less drug is filtered out, creating a situation in which toxicity is easily possible.
    • Glomerular filtration and tubular function are mature by 20 weeks.
  13. First order kinetics
    • A constant fraction of drug is removed per unit of time.
    • Half-life is important here
  14. Zero Order Kinetics
    A constant amount of drug is eliminated per unit of time

    Caffeine, aspirin, diazepam, furosemide, indomethacin, phenytoin, cholramphenicol
  15. LD50
    • Lethal dose in 50% of animals
    • Significantly lower in newborn animals than adult animals
  16. All inhalation anesthetics are ether and based on:
    • methyl ethyl and
    • methyl isopropyl
  17. Which of the ethyl agents are stereoisomers?
    isoflurane and enflurane

    The chloride atom is closer to the ester bridge in isoflurane than enflurane
  18. Does changing from isoflurane to desflurane at the end of the case improve wake-up time?
    No. Isoflurane and desflurane are so much alike, that changing to desflurance will increase the time needed for iso to come out of the tissues
  19. What are the 6 factors that determine uptake of the inhalational anesthetics?
    • 1. Inspired concentration (overpressurization)
    • 2. Alveolar ventilation (increased flow and rate)
    • 3. Functional residual capacity
    • 4. Cardiac Output
    • 5. Solubility
    • 6. Alveolar to venous partial pressure gradient
  20. Define functional residual capacity
    • is the volume of air present in the lungs,
    • specifically the parenchyma tissues, at the end of passive expiration.
  21. Inspired concentration increases works best on what type of agents?
    More soluble. Because the gas leaves the alveoli and enters the blood to be distributed in tissues faster. Remember, alveolar concentration reflects brain and spinal cord concentration
  22. What is the primary determinant of the rate of the delivery to the anesthetic to the lungs?
    The ratio of alveolar ventilation to functional residual capacity
  23. What are the B:G values for the following gases?
    1. N2O
    2. Desflurane
    3. Sevoflurane
    4. Isoflurane
    5. Halothane
    • 1.  0.47
    • 2.  0.42
    • 3.   0.6
    • 4.    1.4
    • 5.    2.5
  24. Herring breuer reflex
    If the alveoli are overventilated and stretched, baroreceptor activation will occur and vagal response will slow down the heart rate
  25. Brevital IV dose
    1-2 mg/kg IV
  26. Brevital rectal dose
    10-30 mg/kg
  27. Pentothal IV
    • without pre-op   5-6 mg/kg
    • additional dosing   0.5-2mg/kg
    • Max dose= 10mg/kg total

    Rectal 20-30mg/kg
  28. Propofol
    • 2.8-3 mg/kg without pre-op meds
    • 5.4 mg/kg for LMA insertion
  29. Ketamine
    • 1-3 mg/kg  IV
    • 5-10 mg/kg IM

    • Redose with 0.5 to 1 mg/kg
    • Outside OR 0.25 to 0.5 mg/kg IV or 1-2 mg/kg IM
  30. Morphine
    IV  0.1- 0.2 mg/kg
  31. Merperidine
    IV  1-2 mg/kg
  32. Fentanyl
    1-3 mcg/kg IV
  33. Remifentanyl
    • IV 0.5-1 mcg/kg
    • 0.25-0.5  mcg/kg/min infusion
  34. Tylenol
    10-20 mg/kg PO
  35. Diazepam
    • 0.2-0.3 mg/kg PO or PR
    • 0.1 - 0.2 mg/kg IV
  36. Versed
    0.05-0.15 mg/kg IV

    0.1 - 0.2 mg/kg IM
  37. Chloral hydrate
    20-75mg po or PR
  38. Risk factors for Retinopathy of Prematurity
    maternal diabetes, exogenous bright light , maternal antihistamine use within 2 weeks of delivery
  39. IN addition to brevital, which drugs can also help to induce seizures?
    Caffiene and theophylline
  40. Factors affecting fentanyl clearance include:
    hepatic blood flow, hepatic function, age dependent changes in Vd
  41. Low dose fentanyl-
    termination of action is dependent on redistribution and liver clearance
  42. High dose fentanyl-
    accumulates in muscle and fat, may see prolonged respiratory depression
  43. The ___ ion is the primary extracellular solute
  44. The _____ ion is the primary intracellular solute
  45. Serum osmolarity
    280-300 mOsm/L

    Primarily regulated by ADH, thirst, and renal concentrating ability
  46. ADH is released when:
    serum osmolality reaches a threshold of 280 mOsm. Threshold is decreased with hypovolemia and hypotension
  47. RAA system
    Stimulated by decreased arterial blood pressure. Renin released by juxtaglomerular cells in glomerulus
  48. What are the three severe congenital defects that always indicate a difficult airway?
    • Pierre Robin
    • Treacher Collins
    • Goldenhar
  49. When do the frontal sinus's develop?
    2-6 years of age
  50. When do the ethmoidal, shpenoidal, and maxillary sinuses develop?
    after 6 years of age
  51. Low birth weight
    infant weighing less than 2500 grams
  52. Very low birth weight
    infant weighing less than 1500 grams
  53. Extremely low birth weight
    infant weighing less than 1000 grams
  54. Micropremie
    Infant weighing less than 750 grams
  55. Preterm means
    infant is born before 37 weeks
  56. Term means
    infant born between 37 and 42 weeks
  57. Post term means
    Infant born after 42 weeks
  58. Prematurity definition
    an infant that weighs less than 2500 grams at birth, regardless of gestational age
  59. Growth
    an increase in physical size
  60. Development
    an increase in complexity and function
  61. What is the best indicator of growth?
  62. What is the most sensitive indicator of well being?
  63. The anterior fontanelle closes at
    9 to 18 months of age
  64. The posterior fontanelle closes at
    about 4 months of age
  65. Craniosynostosis
    premature synostosis of sutures that can result in abnormal head shape and may retard brain growth and development
  66. What are the 3 stages of lung development?
    • G- glandular
    • C- canalicular
    • A- alveolar

    vital 24 week is in canalicular stage
  67. Three types of attachment
    • Securely attached
    • Anxiously attached
    • Insecurely attached
  68. Three dimensions that infants temperament are classified as:
    • Emotionality
    • Activity
    • Sociability
  69. Components of informed consent
    • Competence
    • Decision making ability
    • disclosure
    • autonomy
  70. The two parameters that place patients at most risk of aspiration pneumonitis are:
    • gastric fluid volume > 0.4ml/kg and
    • pH < 2.5
  71. Emergence delirium incidence is highly correlated with:
    preoperative anxiety
  72. doctrine of parens patriae
    The state has an obligation to intervene to protect the interests of incompetent patients

    i.e. Jehovah's Witness and blood products in children
  73. Albumin is
    Alkalotic and acidic or neutral drugs will bind readily with it.